Sometimes Bioethicists Should Get in the Way

In an opinion-editorial in the Boston Globe Harvard psychologist Steven Pinker wrote that the best thing bioethicists can do to help society is to get out of the way:

Biomedical research, then, promises vast increases in life, health, and flourishing. Just imagine how much happier you would be if a prematurely deceased loved one were alive, or a debilitated one were vigorous — and multiply that good by several billion, in perpetuity. Given this potential bonanza, the primary moral goal for today’s bioethics can be summarized in a single sentence. Get out of the way.

Instead of summarizing the various responses that his op-ed elicited, I recommend reading this Nature article by Jyoti Madhusoodanan, “Bioethicists accused of doing more harm than good.”

Pinker’s faith in the success of biotechnology and frustration with constraints placed on research remind me of a quote in a 2006 Nature Reviews article on stem cell research:

This case history again reinforces the old truism that unfettered basic research driven only by scientific curiosity is usually the best way to discover things of enormous practical value.

Nature Reviews Genetics, “From teratocarcinomas to embryonic stem cells and beyond: a history of embryonic stem cell research” by Davor Solter, Volume 7, April 2006.

When this article was written, embryonic stem cell (ESC) research was on the public’s radar, and many opposed extracting stem cells from early embryos because the embryo dies in the process. Additionally, many blamed the Bush administration for placing restrictions on funding, even though his administration actually permitted more funding for ESC research than prior administrations had. However, it was still not “unfettered” research, which frustrated those who had an unqualified faith in ESC research to cure numerous debilitating diseases. This faith was not founded on actual cures, but on a hope that the qualities of these cells could be harnessed for clinical purposes. Furthermore, some of the vitriol that had surrounded the debate suggested that there was no other possible solution. Pluripotent stem cells come from embryos, so we must get them from embryos, so the thinking went. This is a brute-force method of doing science. It is not always bad to go to the obvious solutions first, but in this case, it was morally problematic.

 

"Shinya yamanaka10" by National Institutes of Health - http://nihrecord.od.nih.gov/newsletters/2010/02_19_2010/story1.htm. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Shinya_yamanaka10.jpg#/media/File:Shinya_yamanaka10.jpg

“Shinya yamanaka10” by National Institutes of Health – http://nihrecord.od.nih.gov/newsletters/2010/02_19_2010/story1.htm. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Shinya_yamanaka10.jpg#/media/File:Shinya_yamanaka10.jpg

Flash forward to 2012 when Shinya Yamanaka and Sir John Gordon won the Nobel Prize for discovering how adult stem cells can be converted into pluripotent stem cells, now known as induced pluripotent stem cells (iPSCs). It was in the context of wanting to find an alternative to ESC research that Yamanaka decided to explore iPSCs. In an article in the New York Times, Yamanaka was inspired to work on iPSCs after looking in a microscope at embryos at a fertility clinic. According to Yamanaka,

When I saw the embryos, I suddenly realized there was such a small difference between it and my daughters…I thought, we can’t keep destroying embryos for our research. There must be another way.

 

Indeed, he helped find another way. Not only are iPSCs an ethical alternative to ESCs, but because they can be made from the patient’s own cells, they do not have the same rejection issues that ESCs do. Since Yamanaka and Gordon’s award, there have been many advances in iPSC research. It seems like every week there are promising advances in adult stem cell technology or ways that scientists have optimized iPSCs.

 

Often some of the most creative ideas, whether in science, art, or literature, come out of working within constraints. The “obvious” or brute-force solutions may not be open to us, but the eloquent solutions often are.

 

Pinker and other technologists see bioethicists as naysayers that place restrictions on research at the cost of lives. However, many bioethicists are not putting a lid on research, per se, but on certain kinds of research done in a certain way. Stem cells are a good example. Recombinant DNA is another.

 

Bioethicists ought not to be chastised for challenging scientists to be creative. Scientists are some of the most innovative people you will meet. Calling on them to find creative solutions that are less morally problematic for a large portion of the very society they are seeking to help respects the scientist’s abilities and takes into consideration the context within which their work will operate. Sometimes this means asking scientists to find a more eloquent solution than a brute-force method. It is asking them to find something more eloquent than a bulldozer to exact their often noble goals because that bulldozer, in the process of seeing if it works, may run over a vulnerable population, whether that population is embryos, the children born from germline experimentation, or human subjects.

 

It is not the bioethicist’s role to get out of the way. He has several roles and one of them may be to get in the way of the bulldozer. It is his role to protect against one people group using medicine or technology to oppress another by violating that group’s intrinsic dignity. It is also his role to promote quality science, which includes calling scientists to creative solutions that treat the scientific endeavor and its practitioners with more respect than if they were toddlers let loose in a sandbox.